Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Mod Cs Diff Phys<5Yrs 1St 15
Low
$99
Average
$320
Median
$147
High
$822
Each hospital's average Carefirst rate, under the methodology and billing class chosen below.
13 hospitals; the 90th percentile is 7.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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20 hospital rates
iThe hospitals that file a Carefirst rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | NEMOURS CHILDREN'S HOSPITAL Philadelphia, PA percent of total billed charges · outpatientfrom % of charges | 1 | $695 | $695 | — | — | 1–10 | $695 – $695 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 3 | $104 | $102 | $21 | 21% | — | $74 – $123 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 3 | $104 | $102 | $21 | 21% | — | $74 – $123 |
| 4 | Children's National Hospital Washington, DC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 5 | Children's National Hospital Washington, DC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $109 | $109 | $33 | 31% | — | $75 – $142 |
| 6 | Children's National Hospital Washington, DC professional · fee schedule · both | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 7 | Greater Baltimore Medical Center Towson, MD professional · fee schedule · both | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 8 | Greater Baltimore Medical Center Towson, MD professional · fee schedule · inpatient | 2 | $112 | $109 | $4 | 4% | — | $103 – $112 |
| 9 | Greater Baltimore Medical Center Towson, MD professional · fee schedule · outpatient | 2 | $162 | $157 | $6 | 4% | — | $149 – $162 |
| 10 | Inova Alexandria Hospital Alexandria, VA other · both | 2 | $147 | $147 | $4 | 3% | — | $144 – $151 |
| 11 | Inova Fair Oaks Hospital Fairfax, VA other · both | 2 | $147 | $147 | $4 | 3% | — | $144 – $151 |
| 12 | Inova Fairfax Hospital Falls Church, VA other · both | 2 | $147 | $147 | $4 | 3% | — | $144 – $151 |
| 13 | Inova Loudoun Hospital Leesburg, VA other · both | 2 | $147 | $147 | $4 | 3% | — | $144 – $151 |
| 14 | Inova Mount Vernon Hospital Alexandria, VA other · both | 2 | $147 | $147 | $4 | 3% | — | $144 – $151 |
| 15 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · inpatient | 3 | $104 | $102 | $21 | 21% | — | $74 – $123 |
| 16 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · outpatient | 3 | $104 | $102 | $21 | 21% | — | $74 – $123 |
| 17 | UPMC Hanover Hanover, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $664 | $664 | — | — | — | $664 – $664 |
| 18 | UPMC Hanover Hanover, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $664 | $664 | — | — | — | $664 – $664 |
| 19 | University of Virginia Haymarket Medical Center Haymarket, VA percent of total billed charges · bothfrom % of charges | 2 | $822 | $822 | — | — | — | $822 – $822 |
| 20 | University of Virginia Prince William Medical Center Manassas, VA percent of total billed charges · bothfrom % of charges | 2 | $822 | $822 | — | — | — | $822 – $822 |
← Payers reporting CPT 99155 · Snapshot 20261111T120946Z-9134e7f7